MEDICARE: DARREN ERNST LMP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225700000X	Massage Therapist	MA 00012828	WA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MA 00012828	OTHER	WA	MASSAGE THERAPY

General Provider Information

NPI Number	:	1265741862
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DARREN ERNST LMP

Provider Business Mailing Address
First Line	:	8845 MIDVALE AVE N APT 104
Second Line	:
City	:	SEATTLE
State	:	WA
Zip	:	98103-4081
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1817 QUEEN ANNE AVE N STE 305
Second Line	:
City	:	SEATTLE
State	:	WA
Zip	:	98109-2876
Country	:	US
Telephone Number	:	206-446-9554
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/29/2010
Last Update Date	:	09/29/2010

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